Abstract T P60: Anticoagulation for Patients With Isolated Occlusion of the Internal Carotid Artery Presenting With Stroke

Abstract

Introduction/Background: Current guidelines do not recommend acute anticoagulation in treatment of Acute Ischemic Stroke (AIS) patients, based upon concern for hemorrhagic transformation (HT) and lack of evidence for efficacy in acute stroke. However, anticoagulation may be reasonable in patients with carotid dissection/occlusion and/or intraluminal/intracardiac thrombus. In particular, patients with isolated acute carotid occlusion (not reaching the ICA terminus, with patent Circle of Willis) may benefit from anticoagulation to prevent worsening ischemia from further involvement at the level of the circle of Willis. Methods: We retrospectively analyzed 128 consecutive patients presenting with AIS and ICA occlusion from 07/2008 to 05/2013. Patients with newly (<7 days) diagnosed ICA occlusion (without involvement of the Circle of Willis) were divided into two groups based on the initial treatment within 24 hours of presentation: therapeutic anticoagulation (n=12), and medical management (n=19). Patients receiving iv-tPA or endovascular intervention were excluded. Recurrent stroke or death within 7 days and 3 months were recorded. Results: At three months, of the 12 patients who were anti-coagulated, 1 experienced a recurrent stroke (6 th day) and 1 died. Of the 19 patients who were not anti-coagulated 6 developed recurrent strokes (median 3 days after initial stroke) and 2 died. Hemorrhagic transformation was not seen in either group. In the anticoagulation group, there was a trend towards decreased incidence of early stroke recurrence (< 7 days; 8.3% versus 31.6%, p=0.20), and fewer strokes or deaths within three months (16.7% vs. 42.1%, p=0.24). ICA recanalization was seen in 5 (41.7%) patients who were anticoagulated and 2 (10.5%) patients who were not anti-coagulated (p = 0.07). Conclusion: In a selected population of AIS patients presenting with isolated carotid occlusion (not reaching the ICA terminus and Circle of Willis), anticoagulation appears safe, and may be correlated with fewer early recurrent strokes and increased carotid recanalization on follow up. Larger scale prospective studies for this specific patient population may be justified.